Sociodemographic factors such as women's rights, education level and status in society, in addition to appropriate health reforms with greater financial and political support are urgently needed to ensure underprivileged women in rural PNG have access to family planning, supervised deliveries and skilled emergency obstetric care.
Background
Oral misoprostol is widely used for induction of labour (IOL) in developing countries because of its many advantages. However, limited data exist concerning its safety and efficacy when lower doses are used.
Aim
To determine the safety and efficacy of a low‐dose oral misoprostol regimen (commencing at 12 μg) compared to a standard‐dose regimen (commencing at 25 μg) in Papua New Guinea (PNG) women undergoing IOL.
Materials and Methods
This was an open‐label non‐inferiority randomised controlled trial conducted at a provincial hospital in PNG. Women with singleton pregnancies ≥36 weeks with cephalic presentation and a Bishops score of <6, requiring IOL were enrolled. Both regimens were incremented second‐hourly to a maximum required dose within 24 h or until commencement of labour. The primary outcome was the proportion of women who delivered within 24 h of drug administration without any severe adverse events.
Results
Of the 262 women induced (130 standard‐dose vs 132 low‐dose), rates of successful induction were high for both regimens (120/130 (92%) vs 118/132 (89%); P = 0.52). Fourteen women (11%) in the standard‐dose regimen and 20 (15%) in the low‐dose regimen had severe adverse events. There was no significant difference in the safety profile of the two regimens (106/130 (82%) vs 98/132 (74%); P = 0.18). The induction‐to‐delivery time was significantly shorter in the standard‐dose arm (15.2 ± 8.7 h vs 18.0 ± 9.1 h; P = 0.01).
Conclusion
The standard‐dose regimen for IOL has greater efficacy in reducing induction‐to‐delivery time compared to the low‐dose regimen. There was no significant difference in the number of adverse events between the two regimens.
(Aust N Z J Obstet Gynaecol 2017;57:624–629)
Life-threatening pregnancy-related adverse outcomes and maternal deaths are high in developing countries due to health care systems that are weak and resources that are limited. As laboratory facilities with the capacity to undertake postmortem examinations in order to determine causes of maternal deaths are limited in less developed countries, maternal near-miss cases are increasingly being used as a proxy with the goal of understanding factors associated with maternal mortality as well as morbidity. Even within a developing country, the maternal mortality ratio (MMR) tends to be significantly higher in rural areas than urban areas as there is better access to health care facilities in the urban regions. This prospective observational study aimed to determine the near-miss ratio and MMR as well as understand the contributing factors of maternal near-misses and mortality in a provincial level hospital in the Madang Province in Papua New Guinea (PNG). The majority of women living in this province are underprivileged and reside in rural areas.
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